Term
|
Definition
| emerging pathogens that could be engineered for mass dissemination because of their availability, ease of production and dissemination, mortality rate, and ability to cause a substantial health impact. |
|
|
Term
|
Definition
- H1N1 INFLUENZA
- Hantavirus
- HIV/AIDS
- Nipah virus
- SARS |
|
|
Term
|
Definition
- blister
- blood agents
- choking agents
- incapacitation agents
- nerve agents |
|
|
Term
|
Definition
|
|
Term
|
Definition
- cutaneous burns
- acute radiation syndrome |
|
|
Term
| Biologic weapons - category A |
|
Definition
anthrax
smallpox
salmonella
typhoid |
|
|
Term
| Biologic weapons - Category A |
|
Definition
| Highest priority diseases that pose a risk to national security, are easily transmitted, have high morbidity and mortality, would have a major public health impact and cause panic, and require special public health preparedness. |
|
|
Term
| Biologic weapons - Category B |
|
Definition
| Moderate priority diseases with lower morbidity and mortality and more difficult to disseminate. |
|
|
Term
|
Definition
- E. coli
- Ricin
- S. areus
- Typhus
- viral encephalitis
- abrin toxin
- epsilon toxin |
|
|
Term
| Primary survey for emergency care |
|
Definition
- airway/cervical spine
- breathing
- circulation
- disability/CNS
- exposure
- triage guidelines
- basic first aid
- cardiac arrest and cpr |
|
|
Term
| what guides the primary survey? |
|
Definition
|
|
Term
|
Definition
| inspect for anything that may be causing and obstruction |
|
|
Term
| opening the airway of a pt that is unresponsive and/or with suspicion of trauma |
|
Definition
| a modified jaw thrust maneuver |
|
|
Term
|
Definition
| a bag-valve-mask with a 100% O2 source |
|
|
Term
| interventions geared toward restoring effective circulation |
|
Definition
- cpr
- direct control (direct pressure to visible external bleeding)
- obtaining iv access
- infusions of fluids/blood |
|
|
Term
| typical resus fluids, iv, catheter |
|
Definition
- lactated ringer
- 0.9% NS
- antecubital fossa
- a large bore needle catheter |
|
|
Term
| interventions to alleviate shock |
|
Definition
- admin O2
- apply pressure if bleeding
- raise the feet
- admin blood/iv fluids
- monitor vitals
- provide reassurance and support for anxiety |
|
|
Term
|
Definition
A - alert
V - response to voice
P - response to pain
U - unresponsive |
|
|
Term
| what does hypothermia lead to? |
|
Definition
| vasoconstriction and impaired oxygenation |
|
|
Term
|
Definition
| a life or limb threatening situation |
|
|
Term
|
Definition
| a ct should be treated soon, but that the risk is not life threatening |
|
|
Term
|
Definition
| can generally wait for an extended length of time w/o serious deterioration |
|
|
Term
| triage under mass casualty conditions |
|
Definition
| a military form of triage that is implemented w/a focus of achieving the greatest good for the greatest number of people |
|
|
Term
|
Definition
| a red tag indicating an immediate threat to life |
|
|
Term
|
Definition
| id with a yellow tag indicating major injuries that require immediate txt |
|
|
Term
|
Definition
| green tag, minor injuries that don't require txt |
|
|
Term
|
Definition
| black tag, expected and allowed to die |
|
|
Term
| what to assess for fractures and splinting |
|
Definition
- swelling, deformity, skin integrity
- temp, distal pulses, mobility
- reassess neurovascular status after splinting |
|
|
Term
|
Definition
- refrain from wt bearing
- ice
- compression dressing to minimize swelling
- elevate |
|
|
Term
|
Definition
- hypotension
- tachypnea
- tachycardia
- anxiety
- confusion
- unusual behv
- seizures
- coma |
|
|
Term
|
Definition
| white, waxy areas on exposed skin and tissue injury occurs, full or partial thickness |
|
|
Term
| give for frostnip and frostbite |
|
Definition
| pain meds and a tetanus vaccination |
|
|
Term
| warming a frostbite victim |
|
Definition
| 100.4 - 105.8F bath water |
|
|
Term
|
Definition
|
|
Term
| interventions for hypoxia |
|
Definition
- admin O2
- descend to a lower altitude
- steroids and diuretics |
|
|
Term
| what can hypoxia progress to? |
|
Definition
| cerebral and pulmonary edema |
|
|
Term
|
Definition
- the cessation of cardiac function
- the absence of the carotid pulse in the person 1yr and older
- the absence of the brachial pulse in infants up to 1yr |
|
|
Term
| assessment findings of a pt in cardiac arrest |
|
Definition
- skin has ashy appearance
- no respirations
- pupils dilated |
|
|
Term
| the cause of nontraumatic cardiac arrest in 80-90% of victims |
|
Definition
|
|
Term
| pulse-less electrical activity (PEA) |
|
Definition
| the presence of electrical activity but not sufficient enough to stimulate effective cardiac contractions |
|
|
Term
| in children and infants, cardiac arrest is often secondary to what? |
|
Definition
|
|
Term
| when is defibrillation used for a pt undergoing cardiac arrest? |
|
Definition
| ventricular fibrillation and ventricular tachycardia |
|
|
Term
| the goal of basic life support (BLS) |
|
Definition
| to provide O2 to the vital organs until appropriate advanced resuscitation measures can be initiated or until resuscitative efforts are ordered to be stopped |
|
|
Term
| the goal of advanced cardiac life support (ACLS) |
|
Definition
| the return of spontaneous breathing and circulation |
|
|
Term
| when a defibrillator is immediately available and v-fib or v-tach is confirmed, it can be used |
|
Definition
| prior to the initiation of cpr |
|
|
Term
| the amt of rescue breaths w/o chest compressions for an adol or adult |
|
Definition
- 1 breath every 5-6 secs
- 10-12 breaths/min |
|
|
Term
| the amt of rescue breaths w/o chest compressions for an infant and child |
|
Definition
- 1 breath every 3-5 secs
- 12-20 breaths/min |
|
|
Term
| the amt of rescue breaths given during cpr with an advanced airway, for all ages |
|
Definition
- 1 breath/ 6-8 secs
- 8-10 breaths/min |
|
|
Term
| the med given for VF or pulseless VT |
|
Definition
- epi 1mg IV push every 3-5 mins
or
- vasopressin 40 units IV x 1 only
- switch to epi if no response |
|
|
Term
| other meds that can be considered for VF or pulseless VT |
|
Definition
- amiodarone hcl (Cordarone)
- lidocaine hcl (Xylocaine)
- mag sulfate
- procainamide (Procan SR)
- na bicarb |
|
|
Term
| the amount of defib current that should be delivered for VF or pulseless VT |
|
Definition
|
|
Term
| if PEA rate is slow (bradycardic) what should be admin, and what is the max dose? |
|
Definition
atropine 1mg IV every 3-5 mins
max dose is 0.04mg/kg |
|
|
Term
| the most common causes of pulseless electrical activity (PEA)? the H's? |
|
Definition
- hypovolemia
- hypoxia
- hydrogen ion accumulation resulting in acidosis
- hyper or hypokalemia
- hypothermia |
|
|
Term
| the most common causes of PEA? the T's? |
|
Definition
- tablets/ drug overdoses
- tamponade (cardiac)
- tension pneumothorax
- thrombosis (coronary or pulmonary) |
|
|
Term
| alpha receptor sites and response |
|
Definition
- activate in the arterioles of the skin, viscera and mucous membranes, and veins
- leads to vasoconstriction |
|
|
Term
| beta receptors site and response |
|
Definition
- heart stimulation leads to increased HR, inc myocardial contractility, inc rate of conduction through the av node
- activation of the receptors in the kidney leads to the release of renin |
|
|
Term
| treated first during a disaster |
|
Definition
| pts who are seriously injured and have the greatest chance of full recovery |
|
|
Term
| dopamine site and response? |
|
Definition
| activation of receptors in the kidneys cause the renal blood vessels to dilate |
|
|
Term
| beta 2 receptors site and response |
|
Definition
- heart, lungs, and skeletal muscle: vasodilation
- bronchial: bronchodilation
- liver: glycogenolysis
- skeletal muscle: muscle contraction |
|
|
Term
|
Definition
- incubation period
- prodromal period
- convalescent period
- period of communicability |
|
|
Term
|
Definition
|
|
Term
|
Definition
| the time between the beginning of nonspecific symptoms and the onset of disease specific symptoms |
|
|
Term
| prodromal period - nonspecific symptoms |
|
Definition
lethargy
low-grade fever
fatigue
malaise |
|
|
Term
| prodromal period - disease specific symptoms |
|
Definition
|
|
Term
|
Definition
| Kids are infectious at this point and infectious disease spreads rapidly throughout a community |
|
|
Term
|
Definition
| an accompanying specific rash on the skin |
|
|
Term
|
Definition
| an accompanying specific rash on the mucous membranes |
|
|
Term
|
Definition
| period between when the symptoms first begin to fade and when the child returns to a healthy baseline |
|
|
Term
| Period of Communicability: |
|
Definition
| prodromal to beginning of convalescent period |
|
|
Term
| ss of infection disorder on child |
|
Definition
mouth
lesions on mucous membranes (koplik spots)
white plaques on mms (thrush) |
|
|
Term
| ss of infection disorder on child |
|
Definition
skin
warm and dry from fever, rash
reddened, swollen pharynx (infectious mono pharyngitis)
gray membrane in pharynx (diphtheria)
circular, scaly ring under knee (tinea corposis)
flesh-colored papule on top of foot (plantar wart)
linear abrasions on scalp; sandlike particles on hair shafts (pediculosis) |
|
|
Term
| ss of infection disorder on child |
|
Definition
nose
watery discharge (prodromal symptoms of measles) |
|
|
Term
| ss of infection disorder on child |
|
Definition
swollen parotid glands (mumps)
pinpoint papules on a erythematous base, like around the mouth (herpes simplex)
paroxysmal cough (whooping cough)
oozing, honey-colored, crusty lesions on face and hands (impetigo)
crusty lesions between fingers (scabies) |
|
|
Term
|
Definition
| any nonliving object or substance capable of carrying infectious organisms, such as viruses or bacteria, and hence transferring them from one individual to another. Skin cells, hair, clothing, and bedding are common hospital sources of contamination. |
|
|
Term
| Portal of entry for infections |
|
Definition
- bloodstream
- respiratory
- GI
- skin, muc memb |
|
|
Term
|
Definition
| are neutrophils, and they are usually the first responders |
|
|
Term
|
Definition
| they produce pus (remnants of the organisms, phagocytes, and destroyed tissue) |
|
|
Term
|
Definition
| usually indicates phagocytosis is occurring and the infection is resolving |
|
|
Term
|
Definition
| B lymphocytes and T lymphocytes are produced |
|
|
Term
|
Definition
| (humoral immunity) – they form antibodies specific to the offending antigens that either actively destroy them or active complement |
|
|
Term
|
Definition
| – a special body protein that is capable of lysing cells |
|
|
Term
|
Definition
| (thymus dependent) – killer cells, they can destroy antigens either by direct contact or by the release of lymphokines (eg, interferon) |
|
|
Term
| High risk hospitalized children for infections: |
|
Definition
nutritional deficit
immunosuppressed
indwelling vascular lines or catheters
receiving multiple antibiotic therapy
remain in hospital for > 72 hrs |
|
|
Term
| kinesthetic and visceral stimuli |
|
Definition
| orient the person to the internal environment |
|
|
Term
|
Definition
| awareness and interpretation of stimuli into meaningful info. Takes place in the cerebral cortex |
|
|
Term
|
Definition
| It maintains, enhances, or inhibits cortical arousal |
|
|
Term
| responses to both sensory deprivation and overload |
|
Definition
- perceptual changes (eg, mild distortions or hallucinations)
- cog changes (eg, dec concentration and prob-solving ability)
- affective changes (eg, apathy, anxiety, anger, depression, and rapid mood swings) |
|
|
Term
| cts at risk for sensory deprivation |
|
Definition
homebound or institutionalized
bed rest or isolation precautions
sensory deficits
different culture
affective disorders or disturbances of the NS
certain meds that affect the NS |
|
|
Term
| cts at risk for sensory overload |
|
Definition
pain
ICU
intrusive or uncomfortable eqpt
NS disorders or disturbances |
|
|
Term
| assessment of sensory-perception disturbance: |
|
Definition
a nursing history to ID sensory deficits
physical
mental status
ID of at-risk cts
immediate environment
presence of clinical signs of sensory deprivation or overload |
|
|
Term
| NANDA nursing dx r/t a ct's sensory impairments |
|
Definition
Sensory Perception Disturbances: Visual, Auditory, Gustatory, Olfactory, Tactile, Kinesthetic
Acute Confusion
Chronic Confusion
Impaired Memory
Social Isolation
Impaired Verbal Comms
Risk for Impaired Skin Integrity
Self-Care Deficit: Bathing/Hygiene
Impaired Home Maintenance
Risk for Injury |
|
|
Term
| Goals for persons with sensory-perception disturbances |
|
Definition
maintaining or promoting the function of existing senses
maintaining or improving comm
preventing injury
avoiding sensory deprivation or overload
reducing social isolation
maintaining or restoring ability to function safely in the environment
ADLs |
|
|
Term
| Interventions to prevent or modify sensory deprivation |
|
Definition
sensory overload, and sensory deficits
promoting healthy sensory function
adjusting environmental stimuli
managing sensory deficits |
|
|
Term
| Cts with sensory deficits need |
|
Definition
instructions about sensory aids available to support residual sensory functions
ways to promote the use of other senses
methods to ensure safety from bodily harm |
|
|
Term
| NICs for sensory alterations |
|
Definition
comm enhancement: hearing deficit
“ visual deficit
nutrition mgmt
environmental mgmt
fall prevention
body mechanics promotion
peripheral sensation mgmt
emotional support
surveillance: safety |
|
|
Term
|
Definition
- physical/mechanical
- thermal
- chemical
- radiation
- ecological |
|
|
Term
| common safety hazards - ecological |
|
Definition
| risks posed by changes in the environment as a result of man-made or natural changes. Air, water, and noise pollution are examples of ecological hazards. |
|
|
Term
| common safety hazards - radiation |
|
Definition
| exposure to the sun, heat lamps, tanning booths, and x-rays |
|
|
Term
| common safety hazards - chemical |
|
Definition
| agents present in a person’s surroundings that can potentially cause injury and include medications, poisons, carbon monoxide, radon, and lead paint. |
|
|
Term
| common safety hazards - thermal |
|
Definition
| substances that can cause burns, chills, and fire. These include gas stoves, electrical hazards, and exposure to heat, cold, and fire |
|
|
Term
| common safety hazards - physical/mechanical |
|
Definition
| caused by unsafe physical conditions. These include wet floors, throw rugs that slide, stairs without handrails, poor lighting, improper use of restraints, defective equipment, and unsecured firearms |
|
|
Term
|
Definition
Age
Individual preference
Physical condition
Cultural and spiritual needs ď‚· Socioeconomic factors
Environmental factors
Psychological factors |
|
|
Term
| factors affecting safety - individual preferences |
|
Definition
- lifestyle
- occupation
- risky lifestyle
- use of meds
- history of previous injuries |
|
|
Term
| factors affecting safety - environmental |
|
Definition
- proximity to disaster situations
- occupational
- ergonomic
- neighborhood
- cleanliness |
|
|
Term
| There are four major types of chemical weapons: |
|
Definition
nerve agents
choking/lung/pulmonary agents
cyanides
vesicants or blister agents |
|
|
Term
| Treatments for chemical weapon exposure include |
|
Definition
providing for an open airway, respiratory support
antidotes
specific treatment related to the particular agent
These situations demand an immediate decontamination |
|
|
Term
|
Definition
- biological, chemical, nuclear weapons
- natural disasters
- weapons of terror |
|
|
Term
| There are four key steps to assessing risk |
|
Definition
- develop a communication plan
- plan out how to tackle the emergency
- assign accountability
- Annual update reviews, individual updates for staff regarding particular events, and disaster are provided |
|
|
Term
| Staff education should cover the following points: |
|
Definition
- Identification of potential agents such as anthrax, smallpox, chemical, or nuclear agents
- Mass casualty treatment protocols
- Personal protective equipment for each emergency
- Infection control practices (for example, standard precautions and decontamination).
- Identification of disaster resources and their availability
- Discussion of psychological aspects of bioterrorism (for example anxiety, paranoia, and social isolation)
- Planning for recovery and rehabilitation. |
|
|
Term
| hospital emergency preparedness plan |
|
Definition
- Communication plan (within and outside the hospital)
- Protocols for individual threats to the hospital
- Mass casualty protocols and infection control policies
- Comprehensive education plan for the staff
- Identification of resources needed during a disaster |
|
|
Term
|
Definition
| Etiology Agent - The bacteria Mycobacterium tuberculosis ď‚· Reservoir - Man ď‚· Portal of Exit - Via the respiratory system when the infected person coughs or sneezes ď‚· Means of Transmission - Airborne droplets ď‚· Portal of Entry- Via the respiratory system ď‚· Host - Man |
|
|
Term
| There are six elements in the chain of infection: |
|
Definition
- etiological/infectious agent
- reservoir
- portal of exit
- mode of transmission
- portal of entry
- susceptible host |
|
|
Term
|
Definition
| a host or source of pathogens, which can include another human, a plant, an animal, or even an inanimate object. Humans can be symptomatic or asymptomatic. People who are asymptomatic may also be called “carriers” of that disease. |
|
|
Term
|
Definition
| a route out of the reservoir. These can include the nose and mouth for respiratory diseases. The most common way a blood-borne disease can “exit” is from bleeding, insect bites, and use of syringes and needles. Other portals of exits can include the GI tract and the urethra or genital area |
|
|
Term
|
Definition
| the likelihood the infectious agent will cause illness in an individual |
|
|
Term
| There are four stages in the human response to pathogens: |
|
Definition
| the incubation period, the prodromal stage, the full stage of illness, and the convalescent stage |
|
|
Term
|
Definition
| the time from the initial contact or invasion of the pathogen until the first symptoms appear |
|
|
Term
| Many factors affect the length of the incubation period |
|
Definition
- the virulence and time exposed to the pathogen
- the host’s level of susceptibility |
|
|
Term
|
Definition
- This is the stage where non-specific symptoms first appear
- the host is most infectious
- can last for a few hours or several days
- Fatigue and a low-grade fever are the most common symptoms at this stage
- infected individuals may not realize they are contagious and therefore the disease spreads at this time |
|
|
Term
|
Definition
- signs and symptoms are very specific and individuals recognize that they are sick
- The symptoms can be localized or systemic |
|
|
Term
| The human body’s defense system fights infection through |
|
Definition
- the body’s inflammatory response
- immune response |
|
|
Term
|
Definition
| This is the body’s response to injury or invasion by a pathogen |
|
|
Term
|
Definition
| - the body further controls the invasion by neutralizing the pathogen. The pathogen is neutralized by neutrophils, which surround and consume it. |
|
|
Term
| Inflammatory response - invasion |
|
Definition
| The body further controls the invasion by releasing fluid, cells, and other by-products of the inflammatory process from the wound as exudate. |
|
|
Term
|
Definition
| In this type of defense system, the body identifies the invading microorganisms as foreign bodies or antigens. It then produces antibodies in response to the antigens |
|
|
Term
|
Definition
- standard
- transmission based |
|
|
Term
| types of precautions - standard |
|
Definition
| These are the basic precautions applicable to all patients in health care settings. You need to use these precautions when there is risk of coming in contact with any body fluid, such as blood, secretions, excretions, mucous membranes, and non-intact skin. |
|
|
Term
| types of precautions - transmission based |
|
Definition
These precautions are used in addition to standard
NUR104: Essentials of Nursing Care: Health Safety Module 6
© Excelsior College 2017
precautions for suspected infections that are transmitted by droplet, airborne, or contact routes. |
|
|
Term
|
Definition
| When visibly dirty ď‚· When arriving and leaving patient care unit ď‚· After coming into direct contact with blood, body fluids, secretions, excretions, contaminated items ď‚· Before and after donning gloves ď‚· Between patient contacts |
|
|
Term
| Soiled patient-care equipment |
|
Definition
When handling these, you need to:
ď‚· Ensure that there is no transfer of microorganisms to others and to the environment; ď‚· Wear gloves if the contamination is visible ď‚· Perform hand hygiene |
|
|
Term
| areas of infection control |
|
Definition
- soiled patient care equip
- environmental
- textiles and laundry
- needles and other sharps
- pt resuscitation
- pt placement- respiratory hygiene/cough etiquette |
|
|
Term
| You need to assign single-rooms to patients who are: |
|
Definition
| At increased risk of transmission ď‚· Likely to contaminate the environment ď‚· Not maintaining appropriate hygiene ď‚· At increased risk of acquiring infection or developing adverse outcome following infection |
|
|
Term
| Respiratory hygiene/cough etiquette |
|
Definition
| (source containment of infectious respiratory secretions in symptomatic patients, beginning at initial point of encounter e.g., triage and reception areas in emergency departments and physician offices): |
|
|
Term
|
Definition
- first perform hand hygiene
- Don PPE in the following sequence: gown, mask, eyewear, and gloves. ď‚·
- Select PPE of the correct size.
- Ensure it fits properly and covers all areas it is meant to cover
- Keep hands away from the face. -
- Work from dirty to clean -
- Limit items and surfaces touched.
- Change PPE that is torn or heavily contaminated |
|
|
Term
|
Definition
- gown
- mask
- eyeware
- gloves |
|
|
Term
|
Definition
- at the doorway before leaving the patient’s room or in the anteroom.
- ď‚· Do not touch the outer side of the PPE, which is contaminated.
- ď‚· Remove PPE in the following sequence: gloves, gown, eyewear, and mask. ď‚·
- After removing the gloves and gown, perform hand hygiene before removing the other PPE. ď‚·
- Place the used PPE in the appropriate waste container or the receptacle for reprocessing. ď‚·
- Perform hand hygiene immediately after removing the PPE. |
|
|
Term
| Remove PPE in the following sequence: |
|
Definition
- gloves
-gown
-eyewear
- mask |
|
|
Term
| Several factors affect how people maintain personal hygiene. |
|
Definition
- culture
- environment
- health
- devp level
- personal preference |
|
|
Term
|
Definition
|
|
Term
|
Definition
- clean technique
- handwashing and wearing of gloves |
|
|
Term
|
Definition
|
|
Term
| The purpose of medical asepsis is to |
|
Definition
| confine pathogens and prevent their transmission to others |
|
|
Term
| The purpose of surgical asepsis is to |
|
Definition
| remove pathogenic microbes in order to protect against infection |
|
|
Term
| The practice of hygiene involves |
|
Definition
| caring for one’s skin, eyes, ears, nails, teeth, and genital areas |
|
|
Term
| The Nursing Process and Hygiene - assessment |
|
Definition
need to gather data related to the integumentary system, susceptibility to infection, access to basic hygiene facilities, etc
- Some areas to pay attention to are temperature, presence or absence of moisture, any skin lesions, sensation, color, texture, and vascularity |
|
|
Term
| Wounds are classified as: |
|
Definition
Intentional or accidental
Open or closed
Acute or chronic |
|
|
Term
| Wound depth is classified as: |
|
Definition
Partial thickness
Full thickness
Complex |
|
|
Term
|
Definition
| Hemostasis: the cessation of bleeding ď‚· Inflammation: classic signs are redness, edema, warmth, and pain which typically last four days post injury ď‚· Proliferation: wound repair takes place ď‚· Maturation: remodeling dermal tissue to close the wound |
|
|
Term
| Factors associated with wound healing: |
|
Definition
Local: extent of trauma, edema, pressure, infection, etc.
Systemic: circulation, nutrition, health status, immune system, medication, and the patient’s age |
|
|
Term
| Factors associated with delayed wound healing: |
|
Definition
Infection
Prolonged bleeding |
|
|
Term
|
Definition
Dehiscence: the partial or total separation of the wound edges ď‚· Evisceration: complete separation of the wound with protrusion of viscera. This is a medical emergency.
Other considerations:
ď‚· Pain: Pain is both a physical and psychological component of the trauma caused by wounds. ď‚· Anxiety: Anxiety and fear are common in a patient who has been wounded. Addressing these issues is a very important aspect of caring for the patient. ď‚· Change in body image: This can be a major issue for patients, especially when the wound or scar is visible to others. |
|
|
Term
| Factors associated with the development of pressure ulcers include: |
|
Definition
External pressure: Prolonged pressure on the skin and tissues is, by far, the most common cause of pressure ulcers.
Boney prominences, when exposed to such pressure, are especially vulnerable. ď‚· Shearing and friction: Sliding down in a bed or chair or being pulled across bed sheets are also likely to cause pressure ulcers. |
|
|
Term
| Risk factors associated with the development of pressure ulcers: |
|
Definition
Immobility: Immobility is one of the primary reasons for the development of pressure ulcers.
Moisture: Moisture due to sweat, urine, and feces removes oil from skin, increasing the damage caused by shear and friction.
Nutrition: Protein malnourishment increases the likelihood of cellular damage. Underweight individuals have increased pressure on bony prominences. Overweight individuals may have decreased circulation to the tissue.
Mental status: Patients who are not fully conscious may not be aware of any physical discomfort or be able to reposition themselves.
Age: As a person ages, the skin becomes thin and fragile, increasing the risk of developing pressure ulcers |
|
|
Term
| The stages in a pressure ulcer include: |
|
Definition
Suspected deep tissue injury: There is purple or maroon discoloration of intact skin or blood-filled blisters resulting from damage of underlying soft tissue. ď‚· Stage I: Skin is intact, but not blanchable. ď‚·
Stage II: There is partial thickness loss of the dermis, which is shallow with a pink wound bed.
ď‚· Stage III: There is full thickness loss of the dermis. Fat may be visible, but no other underlying structures are visible. ď‚· Stage IV: There is full thickness loss of dermis with exposed underlying structures such as bones, tendon, and/or muscle. ď‚·
Unstageable: There is full thickness loss that is covered by slough and/or eschar |
|
|
Term
| Braden scale for pressure ulcer risk - The lower the individual scores on the Braden Scale, the higher the chances of developing pressure ulcers |
|
Definition
Sensory perception
Moisture
Activity
Mobility
Nutrition
Shear and friction risk |
|
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Term
|
Definition
SEVERE RISK: Total score 9
HIGH RISK: Total score 10-12
MODERATE RISK: Total score 13-14 MILD RISK: Total score 15-18 |
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Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| antibiotics target the processes of the invading organisms |
|
Definition
some go after protein synthesis
some inhibit DNA or RNA synthesis
some destroy the cell wall |
|
|
Term
|
Definition
|
|
Term
|
Definition
penicillin
cephalosporin: 1-3 generations
tetracyclines
macrolides (erythromycin)
aminoglycosides
quinolones (ciproflaxin)
sulfonamides |
|
|
Term
|
Definition
- skin infections, otitis media, sinusitis, respiratory infections, GU infections
- they kill gram+ and gram– bacteria by destroying the cell walls |
|
|
Term
|
Definition
| - can be used for people who can't tolerate penicillins |
|
|
Term
| 1st generation cephalosporins |
|
Definition
– used mainly for people allergic to penicillin
they act against gram+ bacteria |
|
|
Term
| 2nd generation cephalosporins |
|
Definition
treat nosocomial pneumonia
treat pelvic or intraabdominal infections |
|
|
Term
| 3rd generation cephalosporins |
|
Definition
| act against gram- bacteria |
|
|
Term
|
Definition
they prevent bacteria from making protein (protein synthesis)
useful against gram- and gram+ microbes |
|
|
Term
|
Definition
| a scaly scalp condition often called cradle cap |
|
|
Term
| 3 factors to consider when choosing an antibiotic |
|
Definition
- identity of the infecting organism
- drug sensitivity of the infecting organism
- host factors, such as the site of the infection, and the status of host defenses |
|
|
Term
| reasons for choosing a drug of choice |
|
Definition
- greater efficacy
- lower toxicity
- a more narrow spectrum |
|
|
Term
| conditions that might rule out a first-choice drug |
|
Definition
- allergy to 1st drug of choice
- inability of the drug of choice to penetrate to the site of infection
- heightened susceptibility of the pt to toxicity of the first choice drug |
|
|
Term
| quickest, simplest, and most versatile technique to id a m.org |
|
Definition
|
|
Term
| culture samples should not be exposed to |
|
Definition
- low temp
- antiseptics
- oxygen |
|
|
Term
| microbes that can be detected by a PCR test |
|
Definition
- C. diff
- S. areus
- H. pylori
- HIV
- flu |
|
|
Term
|
Definition
- disk diffusion
- serial dilution
- gradient diffusion |
|
|
Term
|
Definition
| testing a bacteria against different zones of an antibiotic to see which one works |
|
|
Term
| serial dilution establishes |
|
Definition
- the minimum inhibitory concentration (MIC), but does not kill
- the minimum bactericidal conc (MBC) |
|
|
Term
|
Definition
| provides a more precise indication of MIC |
|
|
Term
|
Definition
- immune system
- phagocytic cells |
|
|
Term
| the goal of using antibiotics |
|
Definition
- not to totally kill
- to suppress microbial growth enough to give the host defenses a chance to kill it on their own |
|
|
Term
|
Definition
| to be effective, a drug must be at the site of infection and at a greater conc than the MIC |
|
|
Term
| examples of hampered drug penetration |
|
Definition
- meningitis, because of blood-brain barrier
- endocarditis because of bacterial vegetation
- infected abscesses due to poor vascularity, pus and other materials |
|
|
Term
|
Definition
- use drug that crosses blood-brain barrier, or
- inject drug directly into subarachnoid space |
|
|
Term
| treating abscesses with exudate hindering an antibiotic |
|
Definition
|
|
Term
| drugs with high incidences of allergic reactions by pts |
|
Definition
- penicillin
- sulfonamides
- trimethoprim
- erythromycin |
|
|
Term
| genetic factors can influence |
|
Definition
- a pt's response to a drug
- a pt's rate of metabolism |
|
|
Term
|
Definition
- highly vulnerable to drug toxicity
- use of sulfonamides can cause kernicturis |
|
|
Term
|
Definition
| a severe neurologic disorder caused by displacement of bilirubin from plasma proteins |
|
|
Term
| children/adols and microbials |
|
Definition
| tetracyclines cause discoloration of teeth |
|
|
Term
| pregnant women and microbials |
|
Definition
| gentamicin can cause irreversible hearing loss in the baby |
|
|
Term
| breast-feeding and microbials |
|
Definition
| - sulfonamides in breast milk can cause kernicterus |
|
|
Term
| older adults and microbials |
|
Definition
| reduced rates of metabolism and drug excretion can cause accumulation of toxic levels |
|
|
Term
| successful antimicrobial txt requires |
|
Definition
- it must be at the site of infection
- an effective concentration
- at a sufficient amount of time |
|
|
Term
| the desirable antimicrobial concentration |
|
Definition
|
|
Term
| duration of therapy depends on |
|
Definition
- site of infection
- status of host defenses
- the id of an infecting organism |
|
|
Term
| dangers of stopping antibiotics too early |
|
Definition
- recurrent infection
- the organisms are likely to become more drug resistant than when txt began |
|
|
Term
| Universal precautions – |
|
Definition
| they interfere with the spread of bloodborne pathogens |
|
|
Term
| Body substance isolation (BSI) – |
|
Definition
| it employs generic infection control precautions for all cts except for those with the few diseases xmitted through the air |
|
|
Term
| Transmission-based precautions |
|
Definition
(Tier Two)
airborne
droplet
contact |
|
|
Term
|
Definition
put on gown
put on face mask
don gloves |
|
|
Term
|
Definition
remove gloves first
wash hands
remove face mask
remove gown |
|
|
Term
| Different names are used to identify the same drug and include: |
|
Definition
| Generic: This is the official name of the medication. Most drugs are prescribed using the generic name. For example, levothyroxine sodium. ď‚· Official: This is how the drug is listed in publications and is almost always the generic name. ď‚· Trade/Brand: This is the trademark name used by the drug company. For example, Synthroid. ď‚· Chemical: This is the specific chemical description of the drug. For example, l-thyroxine or T4 |
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|
Term
| There are many forms of medication preparations available. Some of the more common types include: |
|
Definition
| Pills/capsules/tablets: Used for oral administration and generally absorbed the slowest. ď‚· Syrups: Medications that are mixed with water and sugar solution. ď‚· Lotions or Ointments: Medication preparation for a topical application. ď‚· Powders: Finely ground drugs that can be put into another form, such as a capsule, for administration. ď‚· Suppositories: Medication in a form that easily melts for use via the rectum, vagina, or urethra. ď‚· Transdermal Patches: Applied directly to the skin for diffusion to the blood stream |
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|
Term
| routes of drug admin - enteral |
|
Definition
| ď‚· Oral: Medication is administered by mouth in liquid or pill form. ď‚· Via gastrointestinal tubes: Medications are administered through nasogastric, percutaneous endoscopic gastrostomy (PEG) or jejunostomy tubes. ď‚· Buccal: Medicine is placed between the gums and cheek. ď‚· Sublingual: Medicine is placed under the tongue |
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|
Term
| routes of drug admin - parenteral |
|
Definition
| Intramuscular: Medication is injected into muscle tissue. ď‚· Subcutaneous: Drug is injected into the subcutaneous tissue. ď‚· Intravenous: Medication is injected directly into the blood stream through a vein |
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|
Term
| routes of drug admin - topical |
|
Definition
| Transdermal: Medicine is administered through the skin. ď‚· Instillations: The medication is placed into a body cavity. ď‚· Irrigations: A liquid medication is used to wash out a body cavity. ď‚· Nebulizers/Metered Dose Inhalers: Medication is inhaled directly into the lungs |
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|
Term
|
Definition
- absorption
- distribution
- metabolism
- excretion |
|
|
Term
|
Definition
| the process in which drugs alter cell physiology to have their desired effect. A drug can change a body’s processes by promoting, turning on, turning off, or blocking normal responses |
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|
Term
| The types of adverse drug effects are: |
|
Definition
Side effects: Refer to any unintended effect of a drug ď‚· Synergistic effects: Drug-to-drug reaction that increases the effect of one or both drugs when used in combination, which could be desirable or undesirable. ď‚· Antagonistic effects: Drug-to-drug reaction that decreases the effect of one or both drugs when used in combination, which could be desirable or undesirable. ď‚· Toxic effects: Drug effects that could lead to permanent damage or even death. ď‚· Idiosyncratic effects: Unpredicted response to a drug that could be opposite to the intended effect.
Allergic response: This is caused when the body identifies a drug as a foreign body and triggers the immune system to respond by producing antibodies. Allergic effects can be minor or lifethreatening. The most serious allergic effect is called an anaphylactic reaction, which is a medical emergency. ď‚· Drug tolerance: This is caused when the body becomes accustomed to a particular drug and, therefore, higher doses are necessary to achieve a therapeutic effect |
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|
Term
|
Definition
| Refer to any unintended effect of a drug |
|
|
Term
|
Definition
| Drug-to-drug reaction that increases the effect of one or both drugs when used in combination, which could be desirable or undesirable |
|
|
Term
|
Definition
| Drug-to-drug reaction that decreases the effect of one or both drugs when used in combination, which could be desirable or undesirable |
|
|
Term
|
Definition
| Unpredicted response to a drug that could be opposite to the intended effect |
|
|
Term
| factors that can affect drug metabolism, drug action, and patient adherence |
|
Definition
| Gender, economic challenges, lifestyle choices, and dietary practices are |
|
|
Term
|
Definition
| Drugs can affect women and men in different ways. Gender influences how body fat is distributed in a person. For example, men are more prone to have fat deposits in the stomach region. A patient’s body fat distribution has a minor effect on absorption and distribution of medication |
|
|
Term
|
Definition
| Individual patients may have specific preferences related to taking medications. Individual preferences also play a role in the lifestyle choices of patients. Some examples of individual preferences include favoring syrups rather than pills, timing when medication is taken based on daily schedule and waking or sleeping patterns, using alcohol, tobacco and other drugs, and using alternative medicine |
|
|
Term
|
Definition
| The current physical condition of a patient plays an important role in how a medicine affects the patient. Medicines that are known to have severe side effects on a particular organ will have a significant impact on patients in whom the organ is already impaired. Some examples of physical condition impacting drug action are eyesight, physical dexterity, ability to swallow, organ function (affecting excretion and absorption), presence of disease, and presence of food in the system |
|
|
Term
|
Definition
| Storage of medications, expiration dates, sensory deprivation and overload, and nutritional state are all factors to be considered for medication safety |
|
|
Term
|
Definition
| A patient’s ability to schedule and adhere to a schedule and whether the patient believes the medication will help are important influencers of patients taking their medications. Patients with mental illnesses may have impaired reactions or not take medications as prescribed |
|
|
Term
|
Definition
- therapeutic range
- peak level
- trough
- half life |
|
|
Term
|
Definition
| the level of drug concentration that produces the desired effect of the drug |
|
|
Term
| The peak serum drug level is |
|
Definition
| taken once a drug’s absorption is complete. The peak level will depend on the individual drug and the route in which it was administered. The peak level is the highest concentration serum level of a drug. |
|
|
Term
|
Definition
| Question: What is the term for a trademark name by a drug company? Correct Answer: Brand  Question: What is the term for the body becoming unresponsive to the effects to a particular drug? Correct Answer: Drug Tolerance  Question: What is the specific name that describes a drug’s composition? Correct Answer: Chemical  Question: What is the term for the process of elimination of a drug from the body? Correct Answer: Excretion  Question: What is the term for the process in which drugs alter cell physiology to achieve their desired effect? Correct Answer: Pharmacodynamics |
|
|
Term
|
Definition
| Question: What is the term for the undesirable effects of a drug? Correct Answer: Adverse Effects ď‚· Question: What is the term for the side effect where the body identifies the drug as a foreign body and triggers the immune system to respond with antibodies? Correct Answer: Allergic Response ď‚· Question: What is the term for any unintended impacts of a drug? Correct Answer: Side Effects ď‚· Question: What is the term for the unpredicted responses to a drug? Correct Answer: Idiosyncratic Effects |
|
|
Term
|
Definition
| Question: What is the term for the drug reactions that increase the effect of one or both drugs when used in combination? Correct Answer: Synergistic Effects ď‚· Question: What is the term for the drug effects that could lead to permanent damage or even death? Correct Answer: Toxic Effects ď‚· Question: What is the official name that is most commonly used to prescribe drugs? Correct Answer: Generic ď‚· Question: What is the term for the process of transportation of a drug from where it enters the body to the bloodstream? Correct Answer: Absorption |
|
|
Term
|
Definition
| Question: What is the term for how a drug is listed in publications? This name is usually the same as the generic name. Correct Answer: Official ď‚· Question: What is the term for the process of the drug spreading through the body and to the tissues? Correct Answer: Distribution ď‚· Question: What is the term for the process performed by the liver, where the drug is changed from one form into another? Correct Answer: Metabolism |
|
|
Term
|
Definition
|
|
Term
| the most important properties of an ideal drug |
|
Definition
- effectiveness: the most important over all
- safety: even it is admin at high doses over a long period of time
- selectivity: it only elicits the response for which it's given
- there is no such thing as a wholly selective drug |
|
|
Term
| addl properties of an ideal drug |
|
Definition
- reversibility
- predictability
- ease of admin
- freedom from interaction with other drugs
- low cost
- chemical stability: not lose its effectiveness over time
- a simple generic name |
|
|
Term
| the ultimate concern when admin a drug |
|
Definition
| intensity of the response |
|
|
Term
| factors that determine the intensity of a drug response |
|
Definition
- prescribed dose
- admin dose
- conc at sites of action
- intensity of responses |
|
|
Term
| proper drug admin depends on |
|
Definition
- patient adherence
- no med errors |
|
|
Term
|
Definition
| it determines how much of a drug gets to its site of action |
|
|
Term
| the impact of the body on drugs |
|
Definition
- absorption
- distribution
- metabolism
- excretion |
|
|
Term
|
Definition
- impact of the drug on the body
- it determines the nature and intensity of the response
- it's influenced by:
- drug-receptor interaction
- pt's functional state
- placebo effects |
|
|
Term
| sources of individual variation |
|
Definition
| characteristics unique to each pt can influence p.kinetics and p.dynamics |
|
|
Term
| sources of individual variation |
|
Definition
- variables:
- physiologic
- pathologic
- genetic
- drug interactions |
|
|
Term
| sources of individual variation - physiologic |
|
Definition
|
|
Term
| sources of individual variation - pathologic |
|
Definition
| - diminished function of the kidneys and liver |
|
|
Term
| sources of individual variation - genetic |
|
Definition
| can alter the metabolism of drugs and predispose the pt to unique drug reactions |
|
|
Term
| application of the nursing process in drug therapy |
|
Definition
| directed at individualizing txt which is critical to achieving the therapeutic objective |
|
|
Term
| evaluation stage of drug therapy |
|
Definition
- therapeutic responses
- adverse reactions and interactions
- pt adherence
- pt satisfaction with txt |
|
|
Term
| 7 aspects of drug therapy |
|
Definition
- preadmission assessment
- dosage and admin
- evaluating and promoting therapeutic effects
- minimizing adverse effects
- minimizing adverse interactions
- making prn decisions
- managing toxicity |
|
|
Term
| 7 aspects of drug therapy - preadmission assessment |
|
Definition
- develop a baseline to evaluate therapeutic and adverse responses
- id high risk pts
- assess pt's capacity for self-care |
|
|
Term
| measures to reduce adverse events |
|
Definition
- id high risk pts through the pt history
- ensuring proper admin through pt education
- teaching pts about activities that might precipitate adverse events |
|
|
Term
|
Definition
- the major adverse events the drug can produce
- when they are likely to occur
- id early signs
- minimize discomfort and harm |
|
|
Term
| educating the pt on drugs to be given |
|
Definition
- dosage and admin
- drug name (both)
- dosage and admin schedule
- technique of admin
- duration of drug use
- storage |
|
|
Term
| teaching about therapeutic effect |
|
Definition
- what to expect
- how long it will take
- have pt use nondrug techniques also |
|
|
Term
| analysis and nursing diagnosis - 3 phases |
|
Definition
- judge the appropriateness of the prescribed regimen
- id potential health probs the drug might cause
- determine capacity of pt's self-care |
|
|
Term
| highest priority reactions to drugs |
|
Definition
1. life threatening
2. reactions that cause severe, acute discomfort or long term harm |
|
|
Term
| 4 major groups of interventions |
|
Definition
- drug admin
- enhancing therapeutic effects
- minimize adverse effects and interactions
- pt education |
|
|
Term
|
Definition
- lab tests
- observation of the pt
- physical
- pt interviews |
|
|
Term
| evaluating adherence of drug use |
|
Definition
- blood test
- pt interview
- counting pills
- pt understanding of taking the drugs |
|
|
Term
| why a pt won't take a drug |
|
Definition
- too expensive
- too complicated
- bad side effects
- inconvenient dosage schedule
- pt doesn't feel the drug is necessary |
|
|
Term
| federal pure food and drug act 1906 |
|
Definition
| the first American law to regulate drugs |
|
|
Term
| food, drug, and cosmetic act 1938 |
|
Definition
| the first legislation to address drug safety |
|
|
Term
| 1962, harris-kefauver amendments to the food, drug, and cosmetic act |
|
Definition
- the first law that required that drugs must prove to be effective
- it was retroactive
- required rigorous testing |
|
|
Term
| 1970, controlled substance act |
|
Definition
- controlled substances, schedules I-V
- schedule I: no accepted medical use in the US and they have a high potential for abuse
- schedule II-V: accepted medical use in the US and they have a high potential for abuse |
|
|
Term
| 1992, fda regulations permit accelerated approval |
|
Definition
| - drugs for aids and cancer |
|
|
Term
| the prescription drug fee act, 1992 |
|
Definition
| it speeds up the review process for new drugs at the cost of the pharmaceutical process |
|
|
Term
| the fda modernization act, 1997 |
|
Definition
called for widespread changes in fda regulations
- the FastTrack system established for aids and cancer drugs now includes drugs for other serious or life-threatening conditions
- manufacturers that plan to stop making a drug must inform pts at least 6 months in advance
- a clinical trial database is required for drugs made for serious or life-threatening illnesses
- drug companies can now give prescribers journal articles showing off-label use for their drugs |
|
|
Term
| the best pharmaceuticals for children act, 2002 and the pediatric research equality act, 2003 |
|
Definition
designed to promote much needed research on drug safety and efficacy of drugs for children
- it is required by the fda |
|
|
Term
| the fda amendments act, 2007 |
|
Definition
the fda requires new testing on drugs already on the market if they cause any problems to pts
- the fda has the authority to restrict or remove the drug |
|
|
Term
| the family smoking prevention and tobacco control act, 2009 |
|
Definition
| - fda can now regulate cigarettes |
|
|
Term
|
Definition
- random
- controlled
- blind |
|
|
Term
|
Definition
|
|
Term
| preclinical phase, 1-5yrs |
|
Definition
- animals
- tests for toxicities, p.kinetic properties, and potentially useful biologic effects |
|
|
Term
|
Definition
|
|
Term
| clinical trials - phase I |
|
Definition
- healthy volunteers
- evaluates: drug metabolism
- p.kinetics
- drug metabolism |
|
|
Term
| clinical trials - phase II and III |
|
Definition
- patients 5-5000
- determine: therapeutic effects
- dosage range
- safety
- effectiveness |
|
|
Term
| clinical trials - phase IV |
|
Definition
- drug is released for general use
- its effects on the general population is observed |
|
|
Term
| consideration when prescribing a new drug |
|
Definition
| be neither the first to adopt the new, nor the last to abandon the old |
|
|
Term
| when considering a generic over a brand |
|
Definition
| determine if there is a difference in the absorption rate |
|
|
Term
|
Definition
| determines the concentration of a drug at its site of action, and thereby determine the intensity and time course of responses |
|
|
Term
| how drugs cross membranes |
|
Definition
- passing through pores
- undergoing xport
- penetrating the membrane directly |
|
|
Term
|
Definition
- found in the liver, kidney, placenta, intestine, and brain capillaries
- it can xport a variety of drugs OUT of cells |
|
|
Term
| to cross membranes, most drugs must |
|
Definition
| dissolve directly into the lipid bilayer of the membrane |
|
|
Term
|
Definition
| can cross membranes simply |
|
|
Term
| drugs that are polar or ionized |
|
Definition
| can't cross membranes simply |
|
|
Term
| absorption is enhanced by |
|
Definition
- rapid drug dissolution
- high lipid solubility of the drug
- a large surface area for absorption
- high blood flow at the site of admin |
|
|
Term
|
Definition
- rapid onset
- precise control of drug entering the blood
- suitability for use with lg volumes of fluid
- suitability for irritant drugs |
|
|
Term
|
Definition
- high cost
- difficulty
- inconvenience
- danger because of irreversibility
- the potential for fluid overload, infection, and embolism |
|
|
Term
|
Definition
- suitability for insoluble drugs
- suitability for depot preparations |
|
|
Term
|
Definition
- inconvenience
- potential for discomfort |
|
|
Term
|
Definition
- suitability for insoluble drugs
- suitability for depot preparations |
|
|
Term
|
Definition
- inconvenience
- potential for discomfort |
|
|
Term
|
Definition
| metabolism plus excretion |
|
|
Term
| 3 ways to cross a cell membrane |
|
Definition
- passage through channels or pores
- passage with the aid of a transport system
- direct penetration of the membrane itself |
|
|
Term
|
Definition
- multidrug transporter protein
- transports drugs out of cells |
|
|
Term
| the most common ways drugs enter cells |
|
Definition
- direct penetration of the membrane
- drugs must be lipid soluble in order to do it |
|
|
Term
|
Definition
- they are unable to dissolve in the lipid bilayer of the cell membrane
- they are water soluble |
|
|
Term
|
Definition
- when an acid gives up its proton, it becomes negatively charged
- when a base accepts a proton, it becomes positively charged
- acids tend to ionize in basic (alkaline) media
- bases tend to ionize in acidic media |
|
|
Term
|
Definition
- it tends to give up its proton (become ionized) in basic media
- in the stomach, an acidic environment, the aspirin becomes nonionized
- it can then cross the cell membrane in the stomach to the bloodstream
- if the aspirin passes from the stomach to the intestine (an alkaline environment)the aspirin reverts back to being ionized and is impeded from being absorbed
- |
|
|
Term
| ion trapping or pH partitioning |
|
Definition
- acid drugs will accumulate on the alkaline side of a pH gradient
- alkaline drugs will accumulate on the acid side of a pH gradient |
|
|
Term
| a practical example of ion trapping |
|
Definition
| by manipulating urinary pH, we can employ ion trapping to draw toxic substances (poison) from the blood into the urine, thereby accelerating their removal |
|
|
Term
| factors affecting absorption |
|
Definition
- rate of dissolution
- surface area
- pH partitioning
- blood flow
- lipid solubility |
|
|
Term
|
Definition
|
|
Term
| 3 ways iv admin can cause embolisms |
|
Definition
- undissolved particles in solution
- a thrombus can break loose
- RBC can get destroyed, debris from the cells can produce embolism |
|
|
Term
| factors that influence absorption of oral admin |
|
Definition
- solubility and stability of the drug
- gastric and intestinal pH
- gastric emptying time
- food in the gut
- coadmin of other drugs
- special coatings on the drug preparation |
|
|
Term
| drugs that are equal in bioavailability |
|
Definition
| - the drug is absorbed at the same rate and to the same extent |
|
|
Term
|
Definition
- they protect drugs from the acid and pepsin in the stomach
- they protect the stomach from drugs that can cause gastric discomfort |
|
|
Term
|
Definition
- blood flow to the tissues
- the ability of a drug to exit the vascular system
- the ability of a drug to enter cells |
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|
Term
| two pathologic blockages to blood flow |
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Definition
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|
Term
| movement into the interstitial space is not impeded |
|
Definition
| - because drugs pass between capillary cells rather than through them |
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Term
| drugs that are able to cross the BBB |
|
Definition
- lipid soluble, or
- have a transport system |
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Term
|
Definition
| it protects the brain from drugs by pumping drugs out of cells and back into the BBB |
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Term
|
Definition
- biotransformation
- the enzymatic alteration of drug structure |
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|
Term
| drug metabolism in the liver |
|
Definition
- hepatic microsomal enzyme system
- P450 |
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|
Term
| 6 possible therapeutic consequences of drug metabolism |
|
Definition
- accelerated renal excretion of drugs
- drug inactivation
- inc therapeutic action
- activation of prodrugs
- inc toxicity
- dec toxicity |
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|
Term
| the most important consequence of drug metabolism |
|
Definition
- promotion of renal drug excretion
- lipid soluble (hydrophobic) drugs must undergo metabolic conversion to water soluble (hydrophilic) forms in order to be excreted by the kidneys |
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|
Term
| 2 important metabolic transformations to enhance excretion |
|
Definition
- glucuronidation
- addition of a hydroxyl group converts a drug into a more polar (less lipid-soluble) form |
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Term
|
Definition
| a hydrophilic glucose derivative is attached to phenytoin to make it more water soluble |
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Term
|
Definition
| a compound that is pharmacologically inactive as administered and then undergoes conversion to its active form via metabolism |
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|
Term
| special considerations in drug metabolism |
|
Definition
- age
- induction and inhibition of drug-metabolizing enzymes
- nutritional status
- competition between drugs |
|
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Term
|
Definition
| - drugs that act on the liver to inc rates of drug metabolism |
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Term
|
Definition
- the rapid hepatic inactivation of certain oral drugs
- to circumvent the first-pass effect, a drug can be given parenterally |
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Term
|
Definition
- drugs that are metabolized by p450 hepatic enzymes
- the rate they are metabolized is influenced by p450 inducers or inhibitors |
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|
Term
| 3 steps of renal excretion |
|
Definition
- glomerular filtration
- passive tubular reabsorption
- active tubular secretion |
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|
Term
| drugs that are highly lipid soluble |
|
Definition
| undergo extensive passive reabsorption back into the blood until they are converted to more polar forms by the liver |
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|
Term
| for a drug to reach plateau |
|
Definition
|
|
Term
| the time required to reach plateau |
|
Definition
| is independent of dosage size |
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|
Term
| to control too much fluctuation between drug levels |
|
Definition
- give smaller doses at shorter intervals (keeping the total daily dose the same)
- use a continuous infusion
- use a depot prep |
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|
Term
| for a drug with a long half-life |
|
Definition
| it may be necessary to use a loading dose to achieve plateau quickly |
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Term
|
Definition
| 94% will be eliminated over 4 half-lives |
|
|
Term
|
Definition
| the study of the biochemical and physiologic effects of drugs and the molecular mechanisms by which these effects are produced |
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Term
|
Definition
| the biggest effect a drug can produce |
|
|
Term
|
Definition
| - a drug that produces its effects at low doses |
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|
Term
|
Definition
| they have independent qualities |
|
|
Term
| it's almost always reversible |
|
Definition
| the binding of drugs to their receptors |
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|
Term
| the receptors through which drugs act |
|
Definition
| normal points of control for physiologic processes |
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|
Term
| molecules supplied by the body |
|
Definition
| receptor function is regulated by |
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|
Term
| all that drugs can do at receptors |
|
Definition
| mimic or block the action of the body's own regulatory molecules |
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|
Term
|
Definition
| can't give cells new functions |
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|
Term
|
Definition
| they make selective drug action possible |
|
|
Term
| 4 primary families of receptors |
|
Definition
- cell membrane-embedded enzymes
- ligand-gated ion channels
- G protein-coupled receptor systems
- transcription factors |
|
|
Term
|
Definition
- a drug interacts with only one type of receptor
- that receptor type regulates just a few processes |
|
|
Term
|
Definition
- a drug interacts with only one type of receptor
- that receptor type regulates multiple processes |
|
|
Term
|
Definition
| refers to the strength of the attraction between a drug and its receptor |
|
|
Term
|
Definition
|
|
Term
|
Definition
| the ability of a drug to activate receptors |
|
|
Term
|
Definition
| drugs with high intrinsic activity have |
|
|
Term
|
Definition
| molecules that activate receptors |
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|
Term
| in terms of the modified occupancy theory |
|
Definition
- agonists have both affinity and high intrinsic activity
- affinity allows them to bind to receptors
- intrinsic activity allows them to activate the receptor after binding |
|
|
Term
|
Definition
| drugs that prevent receptor activation by endogenous regulatory molecules and by other drugs |
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|
Term
| modified occupancy theory |
|
Definition
- antagonists have affinity for receptors but no intrinsic activity
- affinity allows the antagonist to bind to receptors, but lack of intrinsic activity prevents the bound antagonist from causing receptor activation |
|
|
Term
|
Definition
| they have no observable effects in the absence of agonists |
|
|
Term
| partial agonists can act as agonists if |
|
Definition
| there is no full agonist present |
|
|
Term
| partial agonists can act as antagonists if |
|
Definition
| a full agonist is present |
|
|
Term
| continuous exposure of cells to agonists |
|
Definition
| can result in receptor desensitization (aka refractoriness or down-regulation) |
|
|
Term
| continuous exposure of cells to antagonists |
|
Definition
| can result in hypersensitivity (aka supersensitivity) |
|
|
Term
|
Definition
the dose required to produce a defined therapeutic response in 50% of the population
- its good, to weak, or too strong for some people |
|
|
Term
|
Definition
- LD50:ED50 ratio
- it's a measure of a drug's safety
- the higher the dosage has to be to kill 50% of the population, the safer the drug is
- therefore the higher the ratio of LD to ED, the higher the therapeutic index of the drug |
|
|
Term
| potentiative interactions are |
|
Definition
- beneficial when they inc therap effects
- detrimental adverse effects |
|
|
Term
| inhibitory interactions are |
|
Definition
- beneficial when they dec adverse effects
- detrimental when they dec beneficial effects |
|
|
Term
| competition for protein binding sites |
|
Definition
| rarely results in a sustained or sig inc in plasma levels of free drug |
|
|
Term
| drugs that induce hepatic drug-metabolizing enzymes |
|
Definition
| can accelerate the metabolism of other drugs |
|
|
Term
| when an inducing agent is added to the med regimen |
|
Definition
| it may be necessary to inc the dosages of other drugs |
|
|
Term
| when an inducing agent is dc from the med regimen |
|
Definition
| dosages of other drugs may need to be reduced |
|
|
Term
| reducing the extent of absorption |
|
Definition
| reduces peak therap responses |
|
|
Term
| reducing the rate of absorption |
|
Definition
| merely delays the onset of effects |
|
|
Term
| foods may inc drug toxicity |
|
Definition
the combo of MAO inhibitor with tyramine-rich foods
- It's especially found in aged and fermented foods, such as:
Aged cheeses
Smoked fish
Cured meats
Some types of beer |
|
|
Term
| admin drug on an empty stomach |
|
Definition
| - one hour before a meal, or two hours after |
|
|
Term
|
Definition
| any noxious, unintended, and undesired effect that occurs at normal doses |
|
|
Term
|
Definition
| an adverse drug reaction based on a genetic predisposition |
|
|
Term
| the intensity of an allergic reaction |
|
Definition
| is based on sensitivity, not dosage |
|
|
Term
| drugs that prolong the QT interval |
|
Definition
| pose a risk for torsades de pointes, a dysrhythmia that can progress to v-fib |
|
|
Term
| to reduce the risk of serious reactions, the FDA may require mfgs to create a |
|
Definition
- MedGuide for pts, and/or a
- Risk Eval and Mitigation Strategy |
|
|
Term
| three most common fatal med errors |
|
Definition
- giving an overdose
- giving the wrong drug
- using the wrong route |
|
|
Term
| three most common causes fatal med errors |
|
Definition
- human factors: performance or knowledge deficits
- miscommunication: because of bad handwriting
- confusion caused by similarities in drug names |
|
|
Term
| effective measures for reducing med errors |
|
Definition
- using a safety checklist for high-alert drugs
- replacing handwritten med orders
- having a clinical pharmacist accompany ICU physicians on rounds
- avoiding error-prone abbreviations
- helping and encouraging pts to be active and informed in their hc
- med rec whenever a pt undergoes a transition in care
- a bar code system |
|
|
Term
| dosage adjustments made to account for size |
|
Definition
| are often based on body surface area, rather than simply on body weight |
|
|
Term
|
Definition
| results from adaptive changes that occur in response to prolonged drug exposure |
|
|
Term
|
Definition
|
|
Term
|
Definition
- results from accelerated drug metabolism
- it doesn't inc the MEC |
|
|
Term
| differences in bioavailability |
|
Definition
| they matter most for drugs that have a narrow therapeutic range |
|
|
Term
| predictor of drug responses |
|
Definition
- the specific genetic variations and psychosocial factors shared by some group members that can influence drug responses
- not race |
|
|
Term
| major sources of individual variation |
|
Definition
- poor pt adherence
- med errors |
|
|
Term
|
Definition
- in neonates is slower than adults
- in infants is more rapid than adults |
|
|
Term
| neonate are especially sensitive to |
|
Definition
| drugs that are eliminated primarily by hepatic metabolism |
|
|
Term
|
Definition
| metabolize drugs faster than adults |
|
|
Term
|
Definition
| the process most effected by aging |
|
|
Term
|
Definition
| the rate of absorption may be slowed in older adults, although the ______ of absorption isn't |
|
|
Term
| plasma conc of lipid-soluble drugs |
|
Definition
|
|
Term
| plasma conc of water-soluble drugs |
|
Definition
| may be higher in the elderly |
|
|
Term
| the most important cause of adverse drug reactions in elderly |
|
Definition
| reduced renal function, with resultant drug accumulation |
|
|
Term
| the most important cause of adverse drug reactions in elderly |
|
Definition
| reduced renal function, with resultant drug accumulation |
|
|
Term
| factors underlying the inc in adverse reactions include: |
|
Definition
- polypharmacy
- severe illness
- comorbidities
- txt with dangerous drugs |
|
|
Term
| reasons for unintentional nonadherence in elderly |
|
Definition
- complex regimens
- awkward drug pkg
- forgetfulness
- side effects
- low income
- failure to comprehend instructions |
|
|
Term
| 75% of nonadherence among the elderly is intentional. reasons include: |
|
Definition
- expense
- side effects
- the pt's conviction that the drug is unnecessary or the dose is too high |
|
|
Term
|
Definition
- used to calculate body surface area of a child for drug dosage
- based on ht and wt |
|
|
Term
|
Definition
| preferred routes for children |
|
|
Term
|
Definition
| intravascular and interstitial fluid |
|
|
Term
|
Definition
| the principal ions of ECF |
|
|
Term
|
Definition
| the principal ions in ICF fluid |
|
|
Term
| osmotic pressure and hydrostatic pressure |
|
Definition
| two major pressure gradients created by... |
|
|
Term
| fluid and electrolyte mvmt in the body |
|
Definition
- osmosis
- diffusion
- active transport
- filtration |
|
|
Term
| regulates fluid volume and composition |
|
Definition
- kidneys
- endocrine system
- cv system
- lungs
- gi system |
|
|
Term
|
Definition
- lungs: CO2 - acid
- kidneys: bicarb and H atoms |
|
|
Term
| acid-base imbalance occurs |
|
Definition
- the normal 20:1 ratio of bicarb to carbonic acid is upset
- imbalances may be either respiratory or metabolic in origin |
|
|
Term
|
Definition
| don't mix unmodified insulin with modified insulin |
|
|
Term
| the Z-track method of IM injection |
|
Definition
| recommended to prevent discomfort caused by seepage of the med into subQ tissue |
|
|
Term
| human causes of med errors |
|
Definition
- performance deficits (admin a drug IV instead of IM) 30%
- knowledge deficits 14%
- dosage miscalculation 13% |
|
|
Term
|
Definition
| it must be checked immediately before admin a drug |
|
|
Term
| must read the drug level at least three times |
|
Definition
- first when getting the drug
- right before pouring the drug
- finally after pouring the drug |
|
|
Term
|
Definition
- check what is prescribed
- is the dosage within established guidelines
- is it related to the pt's condition |
|
|
Term
| eval pt's response to a med |
|
Definition
- pt observation
- asking questions about the pt's perspective
- monitoring the pt for adverse effects of the med |
|
|
Term
| correct order of admin a med |
|
Definition
| Reviewing the order on the medication administration record 2. Checking the medication label against the physician’s order 3. Preparing the medication 4. Performing a bedside check of the medication 5. Comparing the patient’s ID band with the name and identification number on the medication administration record 6. Administering the medication 7. Documentation |
|
|
Term
| national pt safety goals for meds |
|
Definition
- must use two pt identifiers when providing care
- all meds in perioperative and other procedural areas should be properly labeled
- reduce the likelihood of pt harm associated with the use of anticoag therapy
- maintain and communicate accurate pt med info |
|
|
Term
|
Definition
step 1 - devp a list of scripts and otc the pt is taking
step 2 - devp a list of meds to be prescribed in collaboration with others on the hc team
step 3 - compare these lists of meds so that there is no omission, duplication, errors in dosage, or med interactions
step 4 - a final list is developed following the decision about which meds will be used
step 5 - teach pt to take care of themselves
step 6 - id safety risks for pts |
|
|
Term
|
Definition
- assess pt
- notify dr and nurse mgr
- follow any orders prescribed
- write a brief, but thorough, clear, and factual description of the error and the steps that were taken afterwards, in the pt's record
- complete any paperwork mandated by your facility such as a special event or occurrence forms and include all steps taken after the error occurred
- don't document in the pt's record that an event report was completed |
|
|
Term
|
Definition
| occur when pts undergo a transition in care |
|
|
Term
| see banned abbreviations on phone |
|
Definition
| see banned abbreviations on phone |
|
|
Term
| cause 80% of med error deaths |
|
Definition
- anticoags
- thrombolytics
- neuromuscular blocking agents |
|
|
Term
|
Definition
|
|
Term
|
Definition
- giving an overdose 36%
- giving the wrong drug 16%
- using the wrong route 10% |
|
|
Term
| 13 major categories of med errors |
|
Definition
|
|
Term
| a medguide is required when the fda has determined that |
|
Definition
- pt adherence to directions for drug use is essential for efficacy, or
- pts need to know about potentially serious effects when deciding to use a drug |
|
|
Term
|
Definition
| a dysrhythmia that can progress to v-fib |
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|
